Bone Mineral Density In Women Research Articles

Volumes of visceral adipose tissue, gynoid and android fat as predictors of reduced bone mineral density in women with menstrual disorders

Volumes of visceral adipose tissue, gynoid and android fat as predictors of reduced bone mineral density in women with menstrual disorders

The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss: A Systematic Review and Meta-analysis.

Study Design Systematic review and meta-analysis. Background It remains unclear whether exercise combining different types of physical activities (combined exercise interventions) would effectively preserve postmenopausal women's bone mineral density (BMD) at different sites. Objective To examine the impact of combined exercise interventions on lumbar spine, femoral neck, total hip, and total body BMD in postmenopausal women. Methods An electronic database search was conducted in PubMed, EMBASE, SPORTDiscus, and Web of Science up to January 1, 2016. Randomized controlled trials that conducted combined exercise interventions and reported BMD values in postmenopausal women were included. Two authors independently extracted the data from individual studies. The primary end point was the change in BMD values from baseline to follow-up. The effect sizes were estimated by the standardized mean difference (SMD) methods using fixed-effects models. Results Eleven randomized controlled trials including 1061 postmenopausal women met the inclusion criteria. The levels of between-study heterogeneity were relatively low (I2<50%). Exercise integrating different physical activities significantly increased lumbar spine (SMD, 0.170; 95% confidence interval [CI]: 0.027, 0.313; P = .019), femoral neck (SMD, 0.177; 95% CI: 0.030, 0.324; P = .018), total hip (SMD, 0.198; 95% CI: 0.037, 0.359; P = .016), and total body (SMD, 0.257; 95% CI: 0.053, 0.461; P = .014) BMD. Combined exercise interventions generated a beneficial effect on femoral neck BMD (SMD, 0.219; 95% CI: 0.034, 0.404; P = .020) in groups with women aged younger than 60 years, and significantly improved lumbar spine BMD (SMD, 0.349; 95% CI: 0.064, 0.634; P = .016) in groups with women aged 60 years or older. Conclusion Our findings suggest that combined exercise interventions appear to be effective in preserving postmenopausal women's BMD at the lumbar spine, femoral neck, total hip, and total body. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(4):241-251. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6969.

Calcium and bone metabolism across women's life stages. Bone metabolism and estrogen/androgen balance in women.

Androgen as well as estrogen has physical, psychological and sexual roles in women. The action of androgen on bone health in women is important. The androgen receptor is expressed in osteoblasts and osteocytes but the mechanism has not been clarified in women. It has been reported that endogenous testosterone level was positively correlated with bone mineral density and higher testosterone level might be associated with decrease in bone fractures. Also, it has been reported that bone mineral density in women who received testosterone with estrogen was higher than that in women who received estrogen alone. However, it is important to pay attention to occur adverse effects such as hirsutism, acne, disorder of liver function and dyslipidemia. In addition, occurrence of breast cancer and endometrial cancer should be considered. In postmenopausal women, appropriate range of circulating testosterone level may play favor roles in various tissues.

Body weight, BMI, and stature have a protective effect on bone mineral density in women with postmenopausal vertebral osteoporosis, whereas greater age at menarche and years after menopause have a negative effect

Abstract Background Osteoporosis is a metabolic bone disease with a risk factor of being female, particularly after the onset of menopause. Objectives To evaluate the influence of age, anthropometric, and reproductive variables on spinal bone mineral density (BMD) in women with postmenopausal vertebral osteoporosis. Methods The study was retrospective and included data from 171 patients with postmenopausal vertebral osteoporosis. We performed both simple and multiple regressions considering BMD in spine as the dependent variable. Coefficients of correlation (r), coefficients of determination (r 2), and their level of significance were calculated. Results The associations between spinal BMD and each of the following variables were extremely significant: age at menarche (P = 0.0003), weight (P &lt; 0.0001), stature (P = 0.0004), and BMI (P &lt; 0.0001). The associations between spinal BMD and age (P = 0.004), and between spinal BMD and number of years after menopause were very significant (P = 0.0093). BMD was not associated with age at menopause or number of reproductive years. For multiple regressions there was an increasing trend of r 2 with increasing number of independent variables included in the analysis: r 2 = 21.84% (2 variables), r 2 = 24.93% (3 variables), 26.45% (4 variables), and r 2 = 27% (5 variables). Conclusion BMD is positively associated with weight, BMI, and stature, and is negatively associated with age, time of menarche, and years after menopause. BMD is not associated with age at menopause and reproductive period.

Ghrelin plasma levels, gastric ghrelin cell density and bone mineral density in women with rheumatoid arthritis.

Generalized bone loss can be considered an extra-articular manifestation of rheumatoid arthritis (RA) that may lead to the occurrence of fractures, resulting in decreased quality of life and increased healthcare costs. The peptide ghrelin has demonstrated to positively affect osteoblasts in vitro and has anti-inflammatory actions, but the studies that correlate ghrelin plasma levels and RA have contradictory results. We aimed to evaluate the correlation between total ghrelin plasma levels, density of ghrelin-immunoreactive cells in the gastric mucosa, and bone mineral density (BMD) in twenty adult women with established RA with 6 months or more of symptoms (mean age of 52.70±11.40 years). Patients with RA presented higher ghrelin-immunoreactive cells density in gastric mucosa (P=0.008) compared with healthy females. There was a positive relationship between femoral neck BMD and gastric ghrelin cell density (P=0.007). However, these same patients presented a negative correlation between plasma ghrelin levels and total femoral BMD (P=0.03). The present results indicate that ghrelin may be involved in bone metabolism of patients with RA. However, the higher density of ghrelin-producing cells in the gastric mucosa of these patients does not seem to induce a corresponding elevation in the plasma levels of this peptide.

Poor Compliance to Hormone Therapy and Decreased Bone Mineral Density in Women with Premature Ovarian Insufficiency.

Premature ovarian insufficiency leads to through infertility and estrogen deficiency. Optimal management encompasses estrogen replacement therapy. Long-term outcome of women with POI is not known. We design a study to evaluate the medical care, hormone replacement therapy compliance and bone mineral density (BMD) in POI women with at least a five-year follow-up after the first evaluation. One hundred and sixty-two patients (37.3±8.0 years) were evaluated (follow-up 7.9±2.8 years). Sixty-nine patients (42.6%) had stopped their hormone replacement therapy (HRT) for at least one year during the follow up period. BMD determination at initial evaluation and at follow-up visit was completed in 92 patients. At first evaluation, 28 patients (30%) had osteopenia and 7 (8%) had osteoporosis. At follow up, 31 women (34%) had BMD impairment with osteopenia in 61% and osteoporosis in 5%. In univariate analysis and multivariate analysis, there was a significant loss of femoral BMD in women who had stopped their HRT for over a year. In conclusion, this first study concerning long-term follow-up of POI patients shows the poor compliance to their HRT, despite its importance in the prevention of bone demineralization. This study reinforces the need for follow up and specific care for POI women.

The Effect of Bone-Loading Exercise on Bone Mineral Density in Women Following Treatment for Breast Cancer: A Systematic Review and Meta-analysis

Purpose: The purpose of this systematic review and meta-analysis was to synthesize the current literature on the effects of bone-loading exercise on bone mineral density (BMD) in women after treatment of breast cancer (BC). Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Web of Science databases were searched through March 31, 2016. A combination of MeSH terms and key words was used: (physical therapy OR physiotherapy OR resistance training OR weight training OR aerobic OR exercise) AND (bone density OR osteoporosis) AND breast cancer. Search terms for PEDro were as follows: (breast cancer AND bone breast cancer) and (breast cancer AND osteoporosis). Studies included were experimental studies that compared any type of bone-loading exercise intervention with a comparison group and reported dual-energy x-ray absorptiometry for assessment of BMD of the lumbar spine and/or proximal femur (femoral neck, trochanter, and/or total hip). Between-group BMD effect sizes and 95% confidence intervals (CIs) were calculated for each study (bone-loading exercise vs usual care/non–bone-loading exercise) and pooled across studies. Risk of bias in and across studies was addressed using the PEDro scale. Results: Five randomized controlled studies were included. Pooled effect sizes were statistically significant, favoring the bone-loading exercise group for proximal femur (d = 0.15; 95% CI, 0.03-0.28) and for lumbar spine BMD (d = 0.14; 95% CI, 0.01-0.27). Conclusion: Results provide modest evidence that bone-loading exercise interventions have statistically and clinically significant effects on proximal femur and lumbar spine BMD in women treated for BC. Further research is warranted to determine the most effective types and intensities of exercise for improving BMD in BC survivors.

Correlation Between Grip Strength and Forearm Bone Mineral Density in Women Over 60 Years of Age

Objective: Our objective was to determine whether grip strength correlates with bone mineral density by body part. Participants and Methods: We studied the data on 86 forearms of 86 women, aged 60 years or older, who had been treated for distal radius fractures at our hospital between October 2007 and October 2013. All the patients underwent DXA (dual-energy x-ray absorptiometry) scans of the second to fourth lumbar vertebrae, the femoral neck, and the forearm bone (divided into 3 parts: ultra-distal [UD], mid-distal [MD], and proximal shaft [shaft]). The grip strength of the hand on the noninjured side was examined twice, and we used the average of the results for analysis. Statistical Analysis: Using Pearson product-moment correlation coefficients, we analyzed the DXA scan results (lumbar vertebrae, femur, and 3 forearm parts) for correlations with age, height, weight, body mass index (BMI), and grip strength. Results: The grip strength on the noninjured side correlated positively with the bone mineral densities of the forearm (UD, MD, and shaft) and the femur (neck), but not with those of the lumbar vertebrae. Discussion: The grip strength on the noninjured side had a stronger correlation with the bone mineral density of the proximal shaft (0.351), which has a high percentage of cortical bone than with those of MD (0.340) and UD (0.338). It also correlated with the mineral density of the femoral neck bone (0.263), but not with that of the lumbar vertebrae. Our results suggest a correlation between cortical bone amount and noninjured side grip strength. Conclusions: Our statistical analyses revealed that grip strength on the noninjured side correlated positively with forearm and femoral neck bone mineral densities, but not with lumbar vertebrae bone mineral densities, in middle-aged and elderly females with distal radius fracture. The resultant values indicated that 12.0 kg of grip is equivalent to −2.5 SD in DXA. Grip strength on the noninjured side can be a surrogate marker for screening osteoporosis.

Reduced prealbumin is associated with bone mineral density in women with osteoporosis

ObjectivesPoor nutritional status is associated with osteoporosis (OP) in postmenopausal women. Moreover, recent studies documented that prealbumin is the best and most widely used parameter to monitor nutrition intervention and is a sensitive predictor of short-term outcome compared with albumin. Therefore, the aim of this study was to examine the association of prealbumin levels with bone mineral density (BMD) in patients with OP. MethodsThis cross-sectional study recruited 664 women. Prealbumin levels and BMD at femoral neck and lumbar spine were measured. Multiple linear regression analysis was performed to assess the correlation between prealbumin and BMD. ResultsResults of this study found that prealbumin levels dropped gradually as BMD decreased. Furthermore, partial correlation analysis revealed that prealbumin was correlated with BMD after adjusting for confounders. Multiple linear regression analysis showed that prealbumin is a significant factor for reduced BMD in women (for BMD at spine L2–4, β = 0.186, P < 0.001; for BMD at femoral neck, β = 0.180, P < 0.001). ConclusionPrealbumin was significantly correlated with BMD after adjusting for traditional cardiovascular risk factors. Further prospective research is warranted to further enhance our understanding of the important role of prealbumin in OP.

Bone mineral density in women treated for various types of gynecological cancer.

Patients with gynecologic cancer frequently experience bone loss due to cancer treatments, including bilateral oophorectomy, chemotherapy and radiotherapy. This study evaluated treatment-associated changes in bone mineral density (BMD) in women with gynecologic cancer and compared changes among patients with different types of gynecologic cancer. BMD of the lumbar spine and femur was retrospectively analyzed using dual-energy X-ray absorptiometry in 118 women who underwent treatment for gynecological cancers and 132 women without gynecologic cancers. The cohort included 55 women with cervical cancer who underwent surgery followed by adjuvant chemotherapy and/or radiation therapy, 33 with endometrial cancer (EC) who underwent surgery followed by adjuvant radiation therapy and 30 with ovarian cancer who underwent bilateral oophorectomy followed by adjuvant platinum-based chemotherapy. Lumbar spine and femoral neck BMD were assessed at baseline and 12 months after treatment. Areal BMD, expressed as grams of mineral/cm2 scanned, was compared with that in young healthy women (T-score). Demographic characteristics and pretreatment BMDs, including T-scores, did not differ among cancer types. After adjustment for factors that can affect T-score, cancer type affected change in T-score 12 months after treatment. After adjustment for pretreatment age, parity, BMI and T-score, T-score 12 months after treatment was significantly lower in the EC than in the other groups. Women treated for gynecological cancer, particularly those with EC who undergo bilateral oophorectomy followed by adjuvant radiation therapy or chemotherapy, should be managed in a timely manner to prevent or minimize bone loss.

Discordance between fat mass index and body mass index is associated with reduced bone mineral density in women but not in men: the Busselton Healthy Ageing Study

The relationship between obesity and BMD is complex. FMI (fat mass (kg) / height (m)2) is a more accurate measure of fatness than BMI, and depending on body composition, some individuals have discordant BMI/FMI categories. We examined associations between FMI, BMI and BMD in participants in the Busselton Healthy Ageing Study. Body composition and BMD of the hip, spine and total body were measured using DXA in 3045 participants (1644 females) aged 45-67years. Using standard BMI/FMI categories, the participants were classified as underweight/fat deficit, normal, overweight/excess fat, obese I and obese II-III. BMI and FMI categories were concordant in 77.3% of females and 71.2% of males. There were 12.9% females and 13.2% males in a higher FMI than BMI category (high body fat for BMI), whereas 9.8% females and 15.6% males were in a lower category (low body fat for BMI). Females with high body fat for BMI had significantly lower covariate-adjusted BMD at the femoral neck, total hip and total body (differences of 3.8, 5.1 and 2.6%, respectively, all P < 0.05) than females with low body fat for BMI and lower total body BMD than women with concordant FMI/BMI (by 1.4%, P = 0.04). In males, BMD did not differ significantly between those who were concordant or discordant for FMI/BMI categories. In women (but not men) with discordant FMI/BMI categories, higher body fat for BMI was associated with lower BMD, suggesting that increased fat mass without an accompanying increase in lean mass may be deleterious to bone.

Sex Differences In Relative Contribution Of Lean Mass And Fat Mass On Bone Mineral Density

There is inconsistent evidence regarding the association between lean body mass, fat mass, and bone mineral density (BMD) between sexes and across various populations. This inconsistency in scientific evidence on these variables presents challenges when applying current evidence on lean body mass, and BMD in clinical scenarios. PURPOSE: The purpose of this study was to further determine the impact of fat mass, lean mass on BMD in both men and women. METHODS: Sixty participants (males: n=24, age: 30.5±14.8; females: n=36, age: 26.3±14.8) participated in the study. Investigators examined BMD and body composition measurements using dual-energy X-ray absorptiometry (DXA). RESULTS: Overall, BMD and lean mass were positively correlated (p < 0.01, r2=0.6). When comparing groups, a statistically significant correlation between lean mass and BMD (p < 0.05, r2=0.4) was found in women, but not in men. There were no significant correlations found between fat mass and BMD for the total sample or by sex. CONCLUSIONS: Higher lean mass is positively associated with greater bone mineral density in women. Future investigations should examine the correlation of fat mass, lean mass distribution and BMD at different sites within the skeletal system.

The Effects Of A 10-week Whole-body Vibration Program On Balance And Lower Body Muscular Strength In Adult Women.

: The purpose of this study was to examine the effects of 10 weeks of whole-body vibration on balance, lower body muscular strength, and bone mineral density in women. The study was comprised of two groups: whole body vibration (WBV, n = 19) and control (CON, n = 16). Both groups completed a 10-week WBV program. The WBV group received a vibratory stimulus while performing lower extremity exercises. The CON group performed the same protocol without vibration. Data were collected on balance, muscular strength and bone mineral density. Two, factorial MANOVAs were used to analyze the data with a significance level of .05. Isometric strength of the quadriceps increased significantly for both groups. The improvement in strength was significantly greater in the WBV group (pre: 128.7 ± 50.8 ft•lb, post: 157.7 ± 51.9 ft•lb) compared to the control group (pre: 129.3 ± 33.9 ft•lb, post: 136.5 ± 33.8 ft•lb). No significant differences were observed between the groups for any other variables. Both groups showed significant improvements over time in the adaptation test (WBV pre: 61.53 ± 3.28 deg/s, post: 52.74 ± 3.37 deg/s; CON pre: 68.19 ± 3.6 deg/s, post: 65.44 ± 3.67 deg/s) and the rising index of the sit-to-stand test (WBV pre: 29.32 ± 9.2 %BW, post: 31.32 ±10.5 %BW; CON pre: 29.81 ± 9.4 %BW, post: 33.3 ± 7.9 %BW). In conclusion, adding WBV to a lower extremity exercise program appears to improve lower body muscular strength.

Serum Bioavailable Vitamin D Concentrations and Bone Mineral Density in Women After Obesity Surgery.

Low bone mass after obesity surgery may arise as a consequence of chronic malabsorption of calcium and vitamin D. However, we have not found any role of serum 25-hydroxyvitamin D or of polymorphisms in the vitamin D receptor gene in previous studies. To investigate the circulating bioavailable 25-hydroxyvitamin D in women after bariatric procedures and its association with bone mass. The study consisted of 91 women on follow-up for 7 ± 2years after bariatric surgery. We measured bone mineral density (BMD), serum parathormone (PTH), 25-hydroxyvitamin D, and vitamin D binding protein (VDBP). All patients were genotyped for two variants in the coding region of VDBP (rs4588 and rs7041). Bioavailable 25-hydroxyvitamin D was calculated in double homozygotes. We found a negative correlation between bioavailable 25-hydroxyvitamin D and PTH (r = -0.373, P = 0.018), but not with BMD at lumbar spine (r = -0.065, P = 0.682) or hip (r = -0.029, P = 0.857). When adjusting by age, similar results were found for PTH (r = -0.441, P = 0.005), BMD at lumbar spine (r = -0.026, P = 0.874) and hip (r = -0.096, P = 0.561). After multivariate linear regression, forcing bioavailable 25-hydroxyvitamin D into the model resulted in a weak significant association with BMD at the lumbar spine (β = - 0.247, P = 0.025). Serum bioavailable 25-hydroxyvitamin D concentrations are not associated with bone mass loss after bariatric surgery in women. The negative association with serum PTH levels suggests that vitamin D supplementation partly improves secondary hyperparathyroidism, yet other mechanisms may contribute to low bone mass after bariatric surgery.

Indentification of the lumbar 1-4 and lumbar 2-4 bone mineral density in women

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Bone mineral density in women with Parkinson's disease

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Do women with restless legs syndrome have less bone loss?

It has been shown that older women have a greater chance of developing bone loss.1 In the article “Reduced bone resorption and increased bone mineral density in women with restless legs syndrome,” the authors asked whether women with restless legs syndrome had changes in bone heath compared to women of similar ages and weights.2

Moving toward a prevention strategy for osteoporosis by giving a voice to a silent disease.

A major unmet challenge in developing preventative treatment programs for osteoporosis is that the optimal timing of treatment remains unknown. In this commentary we make the argument that the menopausal transition (MT) is a critical period in a woman’s life for bone health, and that efforts aimed at reducing fracture risk later in life may benefit greatly from strategies that treat women earlier with the intent of keeping bones strong as long as possible. Bone strength is an important parameter to monitor during the MT because engineering principles can be applied to differentiate those women that maintain bone strength from those women that lose bone strength and are in need of early treatment. It is critical to understand the underlying mechanistic causes for reduced strength to inform treatment strategies. Combining measures of strength with data on how bone structure changes during the MT may help differentiate whether a woman is losing strength because of excessive bone resorption, insufficient compensatory bone formation, trabeculae loss, or some combination of these factors. Each of these biomechanical mechanisms may require a different treatment strategy to keep bones strong. The technologies that enable physicians to differentially diagnose and treat women in a preventive manner, however, have lagged behind the development of prophylactic treatments for osteoporosis. To take advantage of these treatment options, advances in preventive treatment strategies for osteoporosis may require developing new technologies with imaging resolutions that match the pace by which bone changes during the MT and supplementing a woman's bone mineral density (BMD)-status with information from engineering-based analyses that reveal the structural and material changes responsible for the decline in bone strength during the menopausal transition.

Reduced bone resorption and increased bone mineral density in women with restless legs syndrome.

To investigate bone resorption and formation markers as well as bone mineral density in women with restless legs syndrome (RLS). This was a prospective cross-sectional case-control study involving drug-naive women with RLS and age- and body mass index (BMI)-matched female controls. Routine blood analyses, markers of bone formation, procollagen 1 n-terminal peptide, bone resorption, c-telopeptide of type 1 collagen (CTX), sclerostin, and bone mineral density (BMD) were compared between the 2 groups. Pregnant or breastfeeding women and individuals with comorbidities other than iron deficiency, type 2 diabetes mellitus, or hypertension were excluded. A significant increase in lumbar BMD was found among 78 women with RLS as compared to 78 age- and BMI-matched controls (p = 0.001). The proportion of patients with osteopenia as defined by a lumbar T score was significantly lower among patients with RLS (p = 0.040). CTX and sclerostin were significantly lower in patients with RLS (p = 0.006 and p = 0.011, respectively), as were the levels of 25-hydroxy vitamin D3, calcemia, and free T3 (p = 0.017, p = 0.017, and p = 0.002, respectively). Despite lower 25-hydroxy vitamin D3, patients with RLS had lower bone resorption markers, higher lumbar BMD, and lower frequency of lumbar osteopenia. As patients with RLS make movements night and day to decrease the severity of their symptoms, they unconsciously perform exercise, which may potentially explain the better bone profile among patients with RLS than in controls.

Sclerostin antibody prevented progressive bone loss in combined ovariectomized and concurrent functional disuse

Osteoporosis is characterized by low bone mass and compromised trabecular architecture, and is commonly occurred in post-menopausal women with estrogen deficiency. In addition, prolonged mechanical unloading, i.e., long term bed rest, can exaggerate the bone loss. Sclerostin is a Wnt signaling antagonist and acts as a negative regulator for bone formation. A sclerostin-neutralizing antibody (Scl-Ab) increased bone mineral density in women with postmenopausal osteoporosis and healthy men. The objective of this study was to characterize the condition of bone loss in ovariectomized (OVX) rats with concurrent mechanical unloading and evaluate the effect of sclerostin antibody treatment in mitigating the prospective severe bone loss conditions in this model. Four-month-old OVX- or sham-operated female SD rats were used in this study. They were subjected to functional disuse induced by hind-limb suspension (HLS) or free ambulance after 2days of arrival. Subcutaneous injections with either vehicle or Scl-Ab at 25mg/kg were made twice per week for 5weeks from the time of HLS. μCT analyses demonstrated a significant decrease in distal metaphyseal trabecular architecture integrity with HLS, OVX and HLS+OVX (bone volume fraction decreased by 29%, 71% and 87% respectively). The significant improvements of various trabecular bone parameters (bone volume fraction increased by 111%, 229% and 297% respectively as compared with placebo group) with the administration of Scl-Ab are associated with stronger mechanical property and increased bone formation by histomorphometry. These results together indicate that Scl-Ab prevented the loss of trabecular bone mass and cortical bone strength in OVX rat model with concurrent mechanical unloading. The data suggested that monoclonal sclerostin-neutralizing antibody represents a promising therapeutic approach for severe osteoporosis induced by estrogen deficiency with concurrent mechanical unloading.